Approach to hip and groin pain in the athlete and active adult
- Rob Johnson, MD
Rob Johnson, MD
- Professor of Family Medicine and Community Health
- University of Minnesota
- Team Physician
- University of Minnesota Athletics
- Section Editors
- Peter Fricker, MBBS, FACSP
Peter Fricker, MBBS, FACSP
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Exercise, Sports Nutrition, and Miscellaneous; Sports-Related Injuries
- Adjunct Professor
- Griffith University
- Institute of Sport, Exercise, and Active Living
- Victoria University
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Hip and groin injuries occur less frequently than injuries of the knee and ankle in the athletic population but contribute significantly to morbidity among the physically active. The broad differential diagnosis and nonlocalizing pain typical of many hip and groin conditions can make a diagnosis difficult to establish. Injuries of the hip and groin are most easily classified as extra-articular and intra-articular injuries. Unlike most joints of the musculoskeletal system, the hip joint is deep, protected by pelvic musculature, and not readily palpable. In fact, according to some studies, patients with intra-articular hip pathology see an average of 3.3 clinicians before a clear diagnosis is established [1,2]. Thus, an informed, systematic approach to assessment and diagnosis is important.
The evaluation of hip and groin pain in athletic and active adults is reviewed here, including a general scheme for differentiating among the common causes of such pain based upon the history and key clinical findings. Detailed discussions of some of the specific conditions and injuries that cause hip and groin pain are found separately. (See "Greater trochanteric pain syndrome (formerly trochanteric bursitis)" and "Overview of stress fractures" and "Sports-related groin pain or 'sports hernia'" and "Osteitis pubis" and "Hamstring muscle and tendon injuries" and "Adductor muscle and tendon injury" and "Quadriceps muscle and tendon injuries" and "Clinical manifestations and diagnosis of osteoarthritis".)
Hip and groin injuries in children and adolescents, particularly those related to the immature skeleton, are reviewed separately. (See "Approach to hip pain in childhood" and "Approach to the child with a limp" and "Evaluation and management of slipped capital femoral epiphysis (SCFE)" and "Developmental dysplasia of the hip: Clinical features and diagnosis".)
Approximately 10 percent of those seeking care for injuries in offices of sports medicine clinicians present with hip and/or groin pain, usually of a chronic nature . Excluding hip osteoarthritis (OA), as many as 14 percent of adults over 60 years complain of significant hip pain on a weekly basis .
Hip and groin pain encompass a wide variety of conditions and injuries. In a review of 894 young adult athletes (ages 26 to 30) with chronic groin pain who participated in soccer, rugby, and Gaelic sports, 24 different combinations of clinical injury were identified . Isolated injury to the hip joint was common and occurred in 55.98 percent. Common causes of pain included femoroacetabular impingement (FAI), which was more common in males and accounted for 40 percent of the hip joint problems, labral injury, which was more common in females, accounted for 33 percent, and hip OA accounted for 24 percent .
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- ANATOMY AND BIOMECHANICS
- DIAGNOSTIC APPROACH
- ADDITIONAL ULTRASOUND RESOURCES
- COMMON CONDITIONS CAUSING HIP OR GROIN PAIN
- Extra-articular muscle and tendon injuries
- - Common muscle and tendon injuries
- - Snapping hip
- Trochanteric pain syndrome (bursitis)
- - Overview and general findings
- - Nerve entrapments
- - Piriformis syndrome
- Stress fractures
- Osteitis pubis
- Athletic pubalgia (sports hernia)
- Femoroacetabular impingement
- Acetabular labrum injury
- MEDICAL CONCERNS
- SUMMARY AND RECOMMENDATIONS